Association of pattern of thrombocytopenia and serology with timings of plasma leakage in patients of dengue hemorrhagic fever during dengue epidemic 2019 – an experience from Rawalpindi Medical University: A cross sectional study.

Abstract

Objective: To find the association between the patters of thrombocytopenia with the timings and patterns of plasma leakage in patients presenting with dengue hemorrhagic fever (DHF) during the dengue epidemic of 2019, in Rawalpindi city. Study Design: Cross-sectional study. Setting: Department of Medicine, District Headquarter Hospital, Rawalpindi, Pakistan. Period: August to November 2019. Material & Methods: In which patients who were labelled and managed as DHF on the basis of clinical presentation, positive serology and ultrasonic evidence of plasma leakage were included. Demographic profile, clinical features with duration of illness, laboratory investigations including serological markers (NS1, IgG and IgG) and ultrasonic findings were recorded on a self-structured performa and data was analyzed using SPSS v23.0. Results: Two hundred and ninety five patients with DHF were enrolled in the study. There were 2012 males and 83 females (male to female ration of 2.5:1). Mean age of all participants was 32.83 years. 50.5% of the cases were primary infection (based on serology), whereas 38.3% were secondary infection and 11.2% were triple negative infection. In 81.1% of the cases, plasma leakage occurred on the 4^th to 7^th day of illness. In these cases, platelet count was <40,000 cells/mm³ in 13.6% cases, between 40,000 cells/mm³ - 80,000 cells/mm³ in 50.8% cases and greater than 80,000 cells/mm³ in 35.5% cases. Amongst the 17.8% of cases where plasma leakage occurred between 8^th to 10^th days, 56.6% had platelet count greater than 80,000 cells/mm³, 22.6% has platelet count between 40,000 cells/mm³- 80,000 cells/mm³ and 20.8% had platelet count of less than 40,000 cells/mm³. Conclusion: Most people had plasma leakage at day 4-7 of illness, so needed more critical monitoring and admission at 4^th to 7^th day of illness, plasma leakage was observed more commonly in primary as compared to secondary infections and mostly at the day of leakage, platelet count was between 40,000 cells/mm³- 80,000 cells/mm³. Strict monitoring is required from the 4^th day of illness to detect early signs of leakage to decrease the mortality and complications by dengue infection.